Healthcare Provider Details

I. General information

NPI: 1508872839
Provider Name (Legal Business Name): JOINT IMPLANT SURGEONS OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7331 COLLEGE PKWY SUITE 300
FORT MYERS FL
33907-5524
US

IV. Provider business mailing address

7331 COLLEGE PKWY SUITE 300
FORT MYERS FL
33907-5524
US

V. Phone/Fax

Practice location:
  • Phone: 239-337-2003
  • Fax: 239-337-3168
Mailing address:
  • Phone: 239-337-2003
  • Fax: 239-337-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD THOMAS HUMBERT
Title or Position: PRESIDENT
Credential: DO
Phone: 239-337-2003